Overuse seen as main reason for elbow injuries

Overuse seen as main reason for elbow injuries

While it's in the center of the infield, the pitcher's mound is often the center of attention. It also is at the center of an epidemic.

This year alone, more than two dozen professional baseball pitchers have undergone Tommy John surgery, the procedure initiated by the late Dr. Frank Jobe to repair torn or frayed ulnar collateral ligaments in a pitcher's elbow.

Among that group is former Rhea County standout Cory Gearrin of the Atlanta Braves, who injured his right elbow in late March and wound up having the procedure done in New York by Dr. David Altchek, one of the orthopedic surgeons working closely with Major League Baseball on a panel to study causes for the injury.

Unlike many, Gearrin pitched only sparingly in high school. He didn't move from shortstop to the mound full-time until he got to junior college.

"I pitched a little in high school, but it was nothing compared to now where you see kids from a very young age pitching year-round," he said.

Gearrin is one of several Braves including Kris Medlin, Brandon Beachy and Johnny Venters who have undergone Tommy John surgery, but the affliction isn't limited to pro or even college pitchers.

Elliott Dockery, who pitched McCallie to the 2014 Division II state championship, underwent Tommy John surgery before his sophomore season. He pitched some as a junior, but even then his coaches were sensitive to his recovery from surgery and limited his pitch count.

At the state tournament, Dockery got a Tuesday win and then came back two days later to get the title victory.

"That was a little different," he said. "For one, I knew that was probably going to be my last game ever, and, two, you don't get to pitch for a state championship every day. I really wanted to do it.

"I definitely didn't have a problem with it. That was much different than summer ball."

He has very little doubt that overuse led to his injury and subsequent surgery.

"A lot of people tell me it was because I throw a lot of off-speed stuff -- my No. 1 pitch was a slider -- but I tend to disagree," he said. "The reason I had to get surgery was starting and pitching whole games. I'd pitch, have one day's rest and then pitch again the next day. I'm convinced that's the reason there was a fray [in the ligament]."

Gearrin isn't sure when or where he first suffered his injury.

"It's so tough to say besides saying wear and tear or some sort of mechanical issue," Gearrin said. "Doctors that saw me initially thought it was a one-time injury, but when he got in there [for surgery], Dr. Altchek said it had been building for a long time."

His timetable looks good -- he plans to be ready for 2015 spring training and for opening day -- but the right-handed relief specialist has learned much about causes and prevention.

"Pitching is such a specialized action and is unique in sports for the amount of stress it can put on the elbow," Gearrin said. "When kids are young and putting that much stress on still-developing muscles and ligaments, it's just crazy to think about. If it's something a player is good at, there can be tremendous longevity, but to do it too much too early is putting all of that in jeopardy.

"They don't need to concentrate on it 24/7 365 days a year. I would encourage working on athleticism through different kinds of sports or training."

Gearrin, who goes through daily therapy including needling (a procedure similar to acupuncture), said the strength coaches and physicians he's talking with are encouraging different sports or time off.

"Throwing year-round seems to be an issue, and I think pitching and the risks that come with it make it a good idea to take seasons off," Gearrin said. "And doing another sport is a good way to get time off and yet improve as an athlete."

Dizzy Dean rules for youth baseball have specific pitching limits by age group. For example, a 10-year-old must have 48 hours rest if he throws one pitch more than three innings, and he is limited to no more than 12 innings per week. The limits increase by age group, but no pitcher can start a game on the mound, leave and return in that same game.

"Once is kid is taken off the mound, he cannot return to the mound in that game," said local and national Dizzy Dean official Bobby Dunn. "That's something that came from Dr. [James] Andrews. He doesn't think that putting a kid back in the game without a proper warmup is a good thing, so that's why we added that rule."

Andrews, one of the nation's orthopedic gurus, and Dr. Kevin Wilk recently released an app for cell phones called "Throw Like a Pro." It's designed to prevent overuse injuries in young baseball players by establishing proper conditioning habits, workout routines, etc. It also includes things like a pitch counter and a rest calculator for parents and coaches.

The link for the app is http://throwlikeaproapp.com.

Dunn is sold on pitching limits.

"Youngsters will pitch till their arm hurts trying to impress somebody," he said. "A lot of the [surgery-related] problem is overuse. A kid shouldn't be allowed to pitch too much, but there are those that will just let kids pitch, and kids are destroying themselves by trying to make somebody happy."

Contact Ward Gossett at wgossett@timesfreepress.com or 423-886-4765. Follow him at Twitter.com/wardgossett.